Provider Demographics
NPI:1811756778
Name:LYON, DIANA ROSE (LSW)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:ROSE
Last Name:LYON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 PHILLIPS LN
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-7661
Mailing Address - Country:US
Mailing Address - Phone:917-318-5866
Mailing Address - Fax:
Practice Address - Street 1:500 AVENUE S
Practice Address - Street 2:
Practice Address - City:MATAMORAS
Practice Address - State:PA
Practice Address - Zip Code:18336-1649
Practice Address - Country:US
Practice Address - Phone:570-296-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-14
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW137305104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker